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The Future of the Affordable Care Act

Currently, the United States Congress is out on their Presidents Day break. Upon returning next Monday, February 27th, one of the hottest items on their agenda is going to be deciding the fate of the Affordable Care Act (ACA). Now that the Republican Party controls both houses of Congress and the Presidency, it would appear that they have an opportunity to affect major change to our nation’s controversial health care law.

While the number of people who have coverage has risen under the current law, the overall costs for health insurance premiums have risen an average of 25% for citizens across the country. This increase has been a rallying cry for opponents of the law, however, coming to a consensus on how best to replace or repair the legislation has been troublesome at best. Until we have a unified plan put forth before the houses of Congress, we can merely discuss the plans that have been made public thus far. Let’s take a look at some of the major points of the plans that are being circulated. To see side-by-side comparisons, visit Kaiser Family Foundation website.

“A Better Way” – This plan sponsored by House Speaker Paul Ryan is comprehensive in its efforts to address the components of the existing legislation. This plan will repeal the ACA, including the mandates that force people to purchase health insurance. The popular provisions allowing for dependents to retain coverage under their parents plan until age 26 and protection for pre-existing conditions would remain. Individuals would be provided tax credits to use towards the purchase of insurance and insurance companies could compete and sell insurance across state lines. Significant changes to the current Medicare and Medicaid system are also being proposed, including creating block grant funding to the states for them to determine the most effective means of coverage for their residents.

“Obamacare Replacement Act” – Sponsored by Senator Rand Paul, a board-certified Ophthalmologist, is promoting a repeal of most ACA legislation including the requirement for insurance companies to guarantee the issuance and renewal of policies, prohibition periods on pre-existing conditions, and the issuance of lifetime and annual limits. The introduction of more free market principals is in addition to maintaining some of the more popular ACA tenets, including coverage for dependents until age 26. Paul’s proposal also includes provisions for increasing consumer use of Health Savings Accounts and allowing insurance companies to compete across state lines. Much of the Medicaid and Medicare expansion under ACA will remain intact.

“Empowering Patients First Act” – Initially sponsored by Representative Tom Price, an Orthopedic Surgeon who is now the United States Secretary of Health and Human Services, this plan calls for a full repeal of the ACA including mandates, standards for minimum benefits and cost-sharing subsidies. Price’s legislation includes provisions for tax credits of $900 to $3,000 for the purchase of insurance for individuals and also implements high-risk pools with federal grant funding for a period of three years. Allows Association Health Plans and Individual Membership Associations through which health insurance coverage can be purchased. The Price Plan also promotes insurance sales across state lines and expansion of Health Savings Accounts, while repealing most of the Medicaid expansion.

“Patient Freedom Act” – Legislation proposed by Senator Bill Cassidy (R-LA) and Senator Susan Collins (R-MA) would allow states to determine if they wanted to continue participating in the ACA or opt for new insurance programs. Collins and Cassidy contend that this legislation allows for states and individuals to take time in transitioning to new programs. Subsidies for insurance purchasers are continued, albeit at reduced rates, and all Medicaid expansions are continued. Mandates forcing individuals to purchase insurance are repealed, while coverage to age 26 and a prohibition of coverage limits are also features of this legislation. The legislation also includes a significant expansion of grant funding for states to provide Health Savings Accounts, reduce Open Enrollment costs, and portability protection to maintain continuous coverage during lapse periods.

An examination of the above proposals demonstrates that there are many things that legislators can agree upon. For example, it would be surprising to find new health care legislation that doesn’t allow families to cover dependents until the age of 26 or to find a repeal of the protections against pre-existing conditions. That being said, the next three to six months will most assuredly present those of us in the healthcare profession with new challenges to overcome. The bottom line is the same as it always is; our patients will receive the compassion and the care that they deserve and the rest of it will work itself out in due time.

Stay tuned to this space for updates on any new health care legislation as it filters down to the field. Please note that none of the above legislative proposals is being promoted by the editors of this content. It is presented as information only and to provide you, our reader, with an update on the rapidly changing landscape around us. Please share your non-political thoughts in the comment section below or join the friendly discussion on our Facebook page.

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